Skip to main content
Top
Published in: BMC Medical Informatics and Decision Making 1/2020

Open Access 01-12-2020 | Research article

Investigating usability of mobile health applications in Bangladesh

Authors: Muhammad Nazrul Islam, Md. Mahboob Karim, Toki Tahmid Inan, A. K. M. Najmul Islam

Published in: BMC Medical Informatics and Decision Making | Issue 1/2020

Login to get access

Abstract

Background

Lack of usability can be a major barrier for the rapid adoption of mobile services. Therefore, the purpose of this paper is to investigate the usability of Mobile Health applications in Bangladesh.

Method

We followed a 3-stage approach in our research. First, we conducted a keyword-based application search in the popular app stores. We followed the affinity diagram approach and clustered the found applications into nine groups. Second, we randomly selected four apps from each group (36 apps in total) and conducted a heuristic evaluation. Finally, we selected the highest downloaded app from each group and conducted user studies with 30 participants.

Results

We found 61% usability problems are catastrophe or major in nature from heuristic inspection. The most (21%) violated heuristic is aesthetic and minimalist design. The user studies revealed low System Usability Scale (SUS) scores for those apps that had a high number of usability problems based on the heuristic evaluation. Thus, the results of heuristic evaluation and user studies complement each other.

Conclusion

Overall, the findings suggest that the usability of the mobile health apps in Bangladesh is not satisfactory in general and could be a potential barrier for wider adoption of mobile health services.
Appendix
Available only for authorised users
Literature
1.
go back to reference van Heerden A, Tomlinson M, Swartz L. Point of care in your pocket: a research agenda for the field of m-health. Bull World Health Organ. 2012;90:393–4.PubMedPubMedCentralCrossRef van Heerden A, Tomlinson M, Swartz L. Point of care in your pocket: a research agenda for the field of m-health. Bull World Health Organ. 2012;90:393–4.PubMedPubMedCentralCrossRef
2.
go back to reference Istepanian R, Laxminarayan S, Pattichis CS. M-health. New York: Springer Science+ Business Media, Incorporated; 2006. Istepanian R, Laxminarayan S, Pattichis CS. M-health. New York: Springer Science+ Business Media, Incorporated; 2006.
3.
go back to reference Kay M, Santos J, Takane M. mHealth: new horizons for health through mobile technologies. World Health Organ. 2011;64:66–71. Kay M, Santos J, Takane M. mHealth: new horizons for health through mobile technologies. World Health Organ. 2011;64:66–71.
4.
go back to reference Tomlinson M, Solomon W, Singh Y, Doherty T, Chopra M, Ijumba P, Tsai AC, Jackson D. The use of mobile phones as a data collection tool: a report from a household survey in South Africa. BMC Med Inform Decis Mak. 2009;9:51.PubMedPubMedCentralCrossRef Tomlinson M, Solomon W, Singh Y, Doherty T, Chopra M, Ijumba P, Tsai AC, Jackson D. The use of mobile phones as a data collection tool: a report from a household survey in South Africa. BMC Med Inform Decis Mak. 2009;9:51.PubMedPubMedCentralCrossRef
5.
go back to reference Rotheram-Borus MJ, Le Roux IM, Tomlinson M, Mbewu N, Comulada WS, Le Roux K, Stewart J, O’Connor MJ, Hartley M, Desmond K, et al. Philani Plus (+): a Mentor Mother community health worker home visiting program to improve maternal and infants’ outcomes. Prev Sci. 2011;12:372–88.PubMedPubMedCentralCrossRef Rotheram-Borus MJ, Le Roux IM, Tomlinson M, Mbewu N, Comulada WS, Le Roux K, Stewart J, O’Connor MJ, Hartley M, Desmond K, et al. Philani Plus (+): a Mentor Mother community health worker home visiting program to improve maternal and infants’ outcomes. Prev Sci. 2011;12:372–88.PubMedPubMedCentralCrossRef
6.
go back to reference Siedner MJ, Haberer JE, Bwana MB, Ware NC, Bangsberg DR. High acceptability for cell phone text messages to improve communication of laboratory results with HIV-infected patients in rural Uganda: a cross-sectional survey study. BMC Med Inform Decis Mak. 2012;12:56.PubMedPubMedCentralCrossRef Siedner MJ, Haberer JE, Bwana MB, Ware NC, Bangsberg DR. High acceptability for cell phone text messages to improve communication of laboratory results with HIV-infected patients in rural Uganda: a cross-sectional survey study. BMC Med Inform Decis Mak. 2012;12:56.PubMedPubMedCentralCrossRef
7.
go back to reference Haberer JE, Robbins GK, Ybarra M, Monk A, Ragland K, Weiser SD, Johnson MO, Bangsberg DR. Real-time electronic adherence monitoring is feasible, comparable to unannounced pill counts, and acceptable. AIDS Behav. 2012;16:375–82.PubMedPubMedCentralCrossRef Haberer JE, Robbins GK, Ybarra M, Monk A, Ragland K, Weiser SD, Johnson MO, Bangsberg DR. Real-time electronic adherence monitoring is feasible, comparable to unannounced pill counts, and acceptable. AIDS Behav. 2012;16:375–82.PubMedPubMedCentralCrossRef
8.
go back to reference Badri H. Key role for information and communication technology in health care; 2015. Badri H. Key role for information and communication technology in health care; 2015.
9.
go back to reference Mtandao A. Center for Health Market Innovation; 2008. Mtandao A. Center for Health Market Innovation; 2008.
10.
go back to reference XK. Mobile Technology for Monitoring and Evaluation and Health Information Systems in Low- to Middle-Income Countries; 2015. XK. Mobile Technology for Monitoring and Evaluation and Health Information Systems in Low- to Middle-Income Countries; 2015.
11.
go back to reference Chib A, Wilkin H, Ling LX, Hoefman B, Van Biejma H. You have an important message! Evaluating the effectiveness of a text message HIV/AIDS campaign in Northwest Uganda. J Health Commun. 2012;17:146–57.PubMedCrossRef Chib A, Wilkin H, Ling LX, Hoefman B, Van Biejma H. You have an important message! Evaluating the effectiveness of a text message HIV/AIDS campaign in Northwest Uganda. J Health Commun. 2012;17:146–57.PubMedCrossRef
12.
go back to reference Cornelius JB, Lawrence JSS, Howard JC, Shah D, Poka A, McDonald D, White AC. Adolescents’ perceptions of a mobile cell phone text messaging-enhanced intervention and development of a mobile cell phone-based HIV prevention intervention. J Spec Pediatr Nurs. 2012;17:61–9.PubMedCrossRef Cornelius JB, Lawrence JSS, Howard JC, Shah D, Poka A, McDonald D, White AC. Adolescents’ perceptions of a mobile cell phone text messaging-enhanced intervention and development of a mobile cell phone-based HIV prevention intervention. J Spec Pediatr Nurs. 2012;17:61–9.PubMedCrossRef
13.
go back to reference Coomes CM, Lewis MA, Uhrig JD, Furberg RD, Harris JL, Bann CM. Beyond reminders: a conceptual framework for using short message service to promote prevention and improve healthcare quality and clinical outcomes for people living with HIV. AIDS Care. 2012;24:348–57.PubMedCrossRef Coomes CM, Lewis MA, Uhrig JD, Furberg RD, Harris JL, Bann CM. Beyond reminders: a conceptual framework for using short message service to promote prevention and improve healthcare quality and clinical outcomes for people living with HIV. AIDS Care. 2012;24:348–57.PubMedCrossRef
14.
go back to reference Juzang I, Fortune T, Black S, Wright E, Bull S. A pilot programme using mobile phones for HIV prevention. J Telemed Telecare. 2011;17:150–3.PubMedCrossRef Juzang I, Fortune T, Black S, Wright E, Bull S. A pilot programme using mobile phones for HIV prevention. J Telemed Telecare. 2011;17:150–3.PubMedCrossRef
15.
go back to reference Mahmud N, Rodriguez J, Nesbit J. A text message-based intervention to bridge the healthcare communication gap in the rural developing world. Technol Health Care. 2010;18:137–44.PubMedCrossRef Mahmud N, Rodriguez J, Nesbit J. A text message-based intervention to bridge the healthcare communication gap in the rural developing world. Technol Health Care. 2010;18:137–44.PubMedCrossRef
16.
go back to reference M. Hoque and G. Sorwar, “Factors Influencing mHealth Acceptance among Elderly People in Bangladesh,” arXiv preprint arXiv:1606.00874, 2016. M. Hoque and G. Sorwar, “Factors Influencing mHealth Acceptance among Elderly People in Bangladesh,” arXiv preprint arXiv:1606.00874, 2016.
17.
go back to reference Hoque MR, Mazmum MFA, Bao Y. E-health in Bangladesh: current status, challenges, and future direction. Int Technol Manag Rev. 2014;4(2):87–96.CrossRef Hoque MR, Mazmum MFA, Bao Y. E-health in Bangladesh: current status, challenges, and future direction. Int Technol Manag Rev. 2014;4(2):87–96.CrossRef
18.
go back to reference Khan SZ, Shahid Z, Hedstrom K, Andersson A. Hopes and fears in implementation of electronic health Records in Bangladesh. Electron J Informa Syst Dev Ctries. 2012;54:1–18. Khan SZ, Shahid Z, Hedstrom K, Andersson A. Hopes and fears in implementation of electronic health Records in Bangladesh. Electron J Informa Syst Dev Ctries. 2012;54:1–18.
19.
go back to reference Ahmed T, Bloom G, Iqbal M, Lucas H, Rasheed S, Waldman L, Khan AS, Islam R, Bhuiya A. E-health and M-Health in Bangladesh: Opportunities and Challenges (No. IDS Evidence Report; 60). IDS. Ahmed T, Bloom G, Iqbal M, Lucas H, Rasheed S, Waldman L, Khan AS, Islam R, Bhuiya A. E-health and M-Health in Bangladesh: Opportunities and Challenges (No. IDS Evidence Report; 60). IDS.
20.
go back to reference Scolari C. The sense of the interface: applying semiotics to HCI research. Semiotica. 2009;2009(177):1–27.CrossRef Scolari C. The sense of the interface: applying semiotics to HCI research. Semiotica. 2009;2009(177):1–27.CrossRef
21.
go back to reference Zapata BC, Fernández-Alemán JL, Toval A, Idri A. Reusable software usability specifications for mHealth applications. J Med Syst. 2018;42(3):45. Zapata BC, Fernández-Alemán JL, Toval A, Idri A. Reusable software usability specifications for mHealth applications. J Med Syst. 2018;42(3):45.
22.
go back to reference Zapata BC, Fernández-Alemán JL, Idri A, Toval A. Empirical studies on usability of mHealth apps: a systematic literature review. J Med Syst. 2015;39:1.PubMedCrossRef Zapata BC, Fernández-Alemán JL, Idri A, Toval A. Empirical studies on usability of mHealth apps: a systematic literature review. J Med Syst. 2015;39:1.PubMedCrossRef
23.
go back to reference Losa-Iglesias ME, Becerro-de-Bengoa Losa K, López-López D, Jimenez-Fernandez R, Corral-Liria I, Vazquez RR, Gallardo CE, Becerro-de-Bengoa Vallejo R. The Usability of a Heartbeat Measuring Mobile Phone app: an Observational Study. J Med Syst. 2019;43(7):226. Losa-Iglesias ME, Becerro-de-Bengoa Losa K, López-López D, Jimenez-Fernandez R, Corral-Liria I, Vazquez RR, Gallardo CE, Becerro-de-Bengoa Vallejo R. The Usability of a Heartbeat Measuring Mobile Phone app: an Observational Study. J Med Syst. 2019;43(7):226.
24.
go back to reference Maramba I, Chatterjee A, Newman C. Methods of usability testing in the development of eHealth applications: a scoping review. Int J Med Inform. 2019;126:95–104.PubMedCrossRef Maramba I, Chatterjee A, Newman C. Methods of usability testing in the development of eHealth applications: a scoping review. Int J Med Inform. 2019;126:95–104.PubMedCrossRef
25.
go back to reference Fiordelli M, Diviani N, Schulz PJ. Mapping mHealth research: a decade of evolution. J Med Internet Res. 2013;15:5.CrossRef Fiordelli M, Diviani N, Schulz PJ. Mapping mHealth research: a decade of evolution. J Med Internet Res. 2013;15:5.CrossRef
26.
go back to reference Prodhan UK, Rahman MZ, Jahan I. A systematic analysis on the telemedicine services in Bangladesh. In: 1st International Conference on Advanced Information and Communication Technology; 2016. Prodhan UK, Rahman MZ, Jahan I. A systematic analysis on the telemedicine services in Bangladesh. In: 1st International Conference on Advanced Information and Communication Technology; 2016.
27.
go back to reference Ahsan A, Raihan A. Understanding mHealth impact among Aponjon (MAMA Bangladesh) subscribers through a phone survey in Bangladesh. In: Proceedings of the Sixth International Conference on Information and Communications Technologies and Development; 2013. Ahsan A, Raihan A. Understanding mHealth impact among Aponjon (MAMA Bangladesh) subscribers through a phone survey in Bangladesh. In: Proceedings of the Sixth International Conference on Information and Communications Technologies and Development; 2013.
28.
go back to reference Prue CS, Shannon KL, Khyang J, Edwards LJ, Ahmed S, Ram M, Shields T, Hossain MS, Glass GE, Nyunt MM, et al. Mobile phones improve case detection and management of malaria in rural Bangladesh. Malaria J. 2013;12(1):48.CrossRef Prue CS, Shannon KL, Khyang J, Edwards LJ, Ahmed S, Ram M, Shields T, Hossain MS, Glass GE, Nyunt MM, et al. Mobile phones improve case detection and management of malaria in rural Bangladesh. Malaria J. 2013;12(1):48.CrossRef
29.
go back to reference Khatun F, Heywood AE, Ray PK, Hanifi S, Bhuiya A, Liaw S-T. Determinants of readiness to adopt mHealth in a rural community of Bangladesh. Int J Med Inform. 2015;84:847–56.PubMedCrossRef Khatun F, Heywood AE, Ray PK, Hanifi S, Bhuiya A, Liaw S-T. Determinants of readiness to adopt mHealth in a rural community of Bangladesh. Int J Med Inform. 2015;84:847–56.PubMedCrossRef
30.
go back to reference Khatun F, Heywood AE, Ray PK, Bhuiya A, Liaw S-T. Community readiness for adopting mHealth in rural Bangladesh: a qualitative exploration. Int J Med Inform. 2016;93:49–56.PubMedCrossRef Khatun F, Heywood AE, Ray PK, Bhuiya A, Liaw S-T. Community readiness for adopting mHealth in rural Bangladesh: a qualitative exploration. Int J Med Inform. 2016;93:49–56.PubMedCrossRef
31.
go back to reference Eckersberger E, Pearson E, Andersen K, Hossain A, Footman K, Biswas KK, Med D, Nuremowla S, Reiss K. Developing mhealth messages to promote postmenstrual regulation contraceptive use in Bangladesh: participatory interview study. JMIR mHealth and uHealth. 2017;5:12.CrossRef Eckersberger E, Pearson E, Andersen K, Hossain A, Footman K, Biswas KK, Med D, Nuremowla S, Reiss K. Developing mhealth messages to promote postmenstrual regulation contraceptive use in Bangladesh: participatory interview study. JMIR mHealth and uHealth. 2017;5:12.CrossRef
32.
go back to reference Huda TM, Alam A, Tahsina T, Hasan MM, Khan J, Rahman MMM, Siddique AB, Arifeen SE, Dibley MJ. Mobile-based nutrition counseling and unconditional cash transfers for improving maternal and child nutrition in Bangladesh: pilot study. JMIR mHealth uHealth. 2018;6:7.CrossRef Huda TM, Alam A, Tahsina T, Hasan MM, Khan J, Rahman MMM, Siddique AB, Arifeen SE, Dibley MJ. Mobile-based nutrition counseling and unconditional cash transfers for improving maternal and child nutrition in Bangladesh: pilot study. JMIR mHealth uHealth. 2018;6:7.CrossRef
33.
go back to reference Islam MA, Alvi HN, Al Mamun KA. DiaHealth: a smart app for complete diabetes lifestyle management. In: Medical Engineering, Health Informatics and Technology (MediTec), 2016 International Conference on; 2016. Islam MA, Alvi HN, Al Mamun KA. DiaHealth: a smart app for complete diabetes lifestyle management. In: Medical Engineering, Health Informatics and Technology (MediTec), 2016 International Conference on; 2016.
34.
go back to reference Shermi T, Islam MN, Akter S, Elahi SSB, Abdullah WM, Al Mamun KA. Virtual eye doc: an android based app in Bengali. In: Electrical, Computer and Communication Engineering (ECCE), International Conference on; 2017. Shermi T, Islam MN, Akter S, Elahi SSB, Abdullah WM, Al Mamun KA. Virtual eye doc: an android based app in Bengali. In: Electrical, Computer and Communication Engineering (ECCE), International Conference on; 2017.
35.
go back to reference K. Zaman and K. A. Al Mamun, “An evaluation of smartphone apps for preventive healthcare focusing on cardiovascular disease,” in Advances in Electrical Engineering (ICAEE), 2017 4th International Conference on}, 2017. K. Zaman and K. A. Al Mamun, “An evaluation of smartphone apps for preventive healthcare focusing on cardiovascular disease,” in Advances in Electrical Engineering (ICAEE), 2017 4th International Conference on}, 2017.
36.
go back to reference Haque M, Kawsar F, Adibuzzaman M, Ahamed S, Love R, Dowla R, Roe D, Hossain S, Selim R. Findings of e-ESAS: a mobile based symptom monitoring system for breast cancer patients in rural Bangladesh. In: Proceedings of the SIGCHI Conference on Human Factors in Computing Systems; 2012. Haque M, Kawsar F, Adibuzzaman M, Ahamed S, Love R, Dowla R, Roe D, Hossain S, Selim R. Findings of e-ESAS: a mobile based symptom monitoring system for breast cancer patients in rural Bangladesh. In: Proceedings of the SIGCHI Conference on Human Factors in Computing Systems; 2012.
37.
go back to reference Khan F, Das M, Ahammed A. PurpleAid: an mHealth platform to combat health hazards of women. In: Medical Engineering, Health Informatics and Technology (MediTec), 2016 International Conference on; 2016. Khan F, Das M, Ahammed A. PurpleAid: an mHealth platform to combat health hazards of women. In: Medical Engineering, Health Informatics and Technology (MediTec), 2016 International Conference on; 2016.
38.
go back to reference Hoque R, Sorwar G. Understanding factors influencing the adoption of mHealth by the elderly: an extension of the UTAUT model. Int J Med Inform. 2017;101:75–84.PubMedCrossRef Hoque R, Sorwar G. Understanding factors influencing the adoption of mHealth by the elderly: an extension of the UTAUT model. Int J Med Inform. 2017;101:75–84.PubMedCrossRef
39.
go back to reference Akter S, D’Ambra J, Ray P. Service quality of mHealth platforms: development and validation of a hierarchical model using PLS. Electron Mark. 2010;20:209–27.CrossRef Akter S, D’Ambra J, Ray P. Service quality of mHealth platforms: development and validation of a hierarchical model using PLS. Electron Mark. 2010;20:209–27.CrossRef
40.
go back to reference Akter S, Ray P, D’Ambra J. Continuance of mHealth services at the bottom of the pyramid: the roles of service quality and trust. Electron Mark. 2013;23:29–47.CrossRef Akter S, Ray P, D’Ambra J. Continuance of mHealth services at the bottom of the pyramid: the roles of service quality and trust. Electron Mark. 2013;23:29–47.CrossRef
41.
go back to reference Bhuiyan T, Mahmud I, Alam B. Usability analysis of SMS alert system for immunization in the context of Bangladesh. Int J Res Eng Tech. 2013;2:300–5. Bhuiyan T, Mahmud I, Alam B. Usability analysis of SMS alert system for immunization in the context of Bangladesh. Int J Res Eng Tech. 2013;2:300–5.
43.
go back to reference Brooke J. SUS: a retrospective. J Usability Stud. 2013;8(2):29–40. Brooke J. SUS: a retrospective. J Usability Stud. 2013;8(2):29–40.
44.
go back to reference Lucero A. Using affinity diagrams to evaluate interactive prototypes. In: IFIP Conference on Human-Computer Interaction, INTERACT-2015; 2015. Lucero A. Using affinity diagrams to evaluate interactive prototypes. In: IFIP Conference on Human-Computer Interaction, INTERACT-2015; 2015.
45.
go back to reference Nielsen J. 10 usability heuristics for user interface design. Nielsen Norman Group. 1995;1:1. Nielsen J. 10 usability heuristics for user interface design. Nielsen Norman Group. 1995;1:1.
46.
go back to reference Tognazzini B. Principles, techniques, and ethics of stage magic and their application to human interface design. In: CHI '93 Proceedings of the INTERACT '93 and CHI '93 Conference on Human Factors in Computing Systems; 1993. Tognazzini B. Principles, techniques, and ethics of stage magic and their application to human interface design. In: CHI '93 Proceedings of the INTERACT '93 and CHI '93 Conference on Human Factors in Computing Systems; 1993.
47.
go back to reference Gerrett JJ. Meet The Elements. In: The Elements of User Experience, New Riders; 2010. p. 25–33. Gerrett JJ. Meet The Elements. In: The Elements of User Experience, New Riders; 2010. p. 25–33.
48.
go back to reference B. Schneiderman, “Designing the user Interface: strategies for effective human-computer interaction. 1998,” Chapter, vol. 15, pp. 510--590, 1998. B. Schneiderman, “Designing the user Interface: strategies for effective human-computer interaction. 1998,” Chapter, vol. 15, pp. 510--590, 1998.
50.
go back to reference Jiménez C, Rusu C, Roncagliolo S, Inostroza R, Rusu V. Evaluating a methodology to establish usability heuristics. In: 2012 31st International Conference of the Chilean Computer Science Society; 2012. Jiménez C, Rusu C, Roncagliolo S, Inostroza R, Rusu V. Evaluating a methodology to establish usability heuristics. In: 2012 31st International Conference of the Chilean Computer Science Society; 2012.
51.
go back to reference Bangor A, Kortum PT, Miller JT. An empirical evaluation of the system usability scale. In: International Journal of Human–Computer Interaction; 2008. Bangor A, Kortum PT, Miller JT. An empirical evaluation of the system usability scale. In: International Journal of Human–Computer Interaction; 2008.
Metadata
Title
Investigating usability of mobile health applications in Bangladesh
Authors
Muhammad Nazrul Islam
Md. Mahboob Karim
Toki Tahmid Inan
A. K. M. Najmul Islam
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Medical Informatics and Decision Making / Issue 1/2020
Electronic ISSN: 1472-6947
DOI
https://doi.org/10.1186/s12911-020-1033-3

Other articles of this Issue 1/2020

BMC Medical Informatics and Decision Making 1/2020 Go to the issue